Provider Demographics
NPI:1780326694
Name:KEMBLE, MACY (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:KEMBLE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CHINOOK TRL
Mailing Address - Street 2:
Mailing Address - City:MEDFORD LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-1610
Mailing Address - Country:US
Mailing Address - Phone:609-410-8959
Mailing Address - Fax:
Practice Address - Street 1:8 CHERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:CLEMENTON
Practice Address - State:NJ
Practice Address - Zip Code:08021-5612
Practice Address - Country:US
Practice Address - Phone:856-566-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-21-55415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst